Investigation of Ceftazidime-Avibactam Susceptibility in Multidrug Resistant Gram Negative Bacteria

Abstract

Multi-drug resistant (MDR) Gram-negative bacterial pathogens may cause infections with serious mortality and morbidity. Treatment options for infections caused by these isolates are limited. The aim of our study was to investigate the ceftazidime-avibactam susceptibility rate in MDR Gram negative bacteria isolated from various clinical samples. Enterobacterales and Pseudomonas aeruginosa strains isolated from various clinical samples in Düzce University Medical Microbiology Laboratory between July 2018 and July 2022 were included in the study. In addition to classical methods, an automated system (VITEK 2 Compact /Phoenix) was used for species level identification and antimicrobial susceptibility testing. Ceftazidime-avibactam (10-4 µ) (Bioanalyse, Turkey) susceptibility was investigated by disc diffusion method in the MDR isolates. A total of 116 strains, including 83 MDR Enterobacterales and 33 MDR-P. aeruginosa, were isolated from various clinical samples. Forty-five (38.7%) of the isolates were susceptible to ceftazidime-avibactam. Ceftazidime-avibactam susceptibility was 44.6% for Enterobacterales and 24.2% for P. aeruginosa strains. In conclusion, the most effective antibiotic against MDR Enterobacterales was colistin (p<0.001) and, the second was ceftazidime-avibactam (p<0.001) in our study. Although the most effective antibiotic against MDR P. aeruginosa strains was also colistin (p<0.001); the susceptibilities to gentamicin, amikacin and ceftazidime-avibactam were similar (p<0.819). Studies have shown that resistance rates of P. aeruginosa to ceftazidime-avibactam were higher than other Gram negative pathogens. Our results indicate that ceftazidime-avibactam may be an alternative for the treatment of infections caused by MDR-Enterobacterales; However, they suggest that susceptibility test results are important for MDR-P. aeruginosa strains.

Keywords

• ceftazidime-avibactam
• Enterobacterales
• multidrug resistance
• P. aeruginosa

ÇOK İLACA DİRENÇLİ GRAM NEGATİF BAKTERİLERDEKİ SEFTAZİDİM-AVİBAKTAM DUYARLILIĞININ ARAŞTIRILMASI

Abstract

Çoklu ilaca dirençli (MDR) Gram negatif bakteriyel patojenler ciddi mortalite ve morbidite ile seyreden enfeksiyonlara neden olabilirler. Bu izolatların etken olduğu enfeksiyonlarda tedavi seçenekleri sınırlıdır. Çalışmamızda çeşitli klinik örneklerden izole edilen MDR Gram negatif bakterilerde seftazidim-avibaktam duyarlılık oranının araştırılması amaçlanmıştır. Çalışmaya Düzce Üniversitesi Tıbbi Mikrobiyoloji Laboratuvarında Temmuz 2018-Temmuz 2022 tarihleri arasında çeşitli klinik örneklerden izole edilen Enterobacterales ve Pseudomonas aeruginosa suşları dahil edildi. Tür düzeyinde tanımlama ve antimikrobiyal duyarlılık testleri için klasik yöntemlere ilave olarak otomatize sistem (VITEK 2 Compact /Phoenix) kullanıldı. Bunların içinden MDR olduğu saptanan izolatlarda disk difüzyon yöntemi ile seftazidim-avibaktam (10-4 µ) (Bioanalyse, Türkiye) duyarlılığı araştırıldı. Çeşitli klinik örneklerden toplam 83 adet MDR Enterobacterales ve 33 adet MDR P. aeruginosa olmak üzere 116 suş izole edildi. İzolatların 45’i (%38.7) seftazidim-avibaktama duyarlı bulundu. Seftazidim-avibaktam duyarlılığı Enterobacterales için %44.6 iken, P. aeruginosa suşlarında %24.2 olarak saptandı. Sonuç olarak çalışmamızda, MDR Enterobacterales’te en etkili antibiyotik kolistin (p<0.001), ikinci seftazidim-avibaktam (p<0.001) oldu. MDR P. aeruginosa suşlarında da en etkili antibiyotik kolistin (p<0.001) olmakla birlikte; gentamisin, amikasin ve seftazidim-avibaktam duyarlılıklarının benzer olduğu görüldü (p<0.819). Yapılan çalışmalarda P. aeruginosa'nın seftazidim-avibaktama karşı direnç oranlarının diğer Gram-negatif patojenlere göre daha yüksek olduğu gösterilmiştir. Sonuçlarımız seftazidim-avibaktamın MDR-Enterobacterales ile gelişen enfeksiyonların tedavisi için bir alternatif olabileceğini; ancak, MDR-P. aeruginosa suşlarında duyarlılık test sonuçlarının önemli olduğunu düşündürmektedir.

Keywords

• çoklu ilaç direnci
• Enterobacterales
• P. aeruginosa
• seftazidim-avibaktam

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